Micha T. Maeder, Alexander Breuss, Sharon Appert, Simon Wildermuth, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Martin O. Schmiady, Hans Rickli, Lukas Weber
Background
Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).
Methods
Consecutive patients with severe AS with [n = 157; median (interquartile range) daily torasemide dose: 10 (5–15) mg] or without (n = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied.
Results
Despite similar AS severity (indexed aortic valve area 0.41 ± 0.12 vs. 0.43 ± 0.12 cm2/m2) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B-type natriuretic peptide [446 (245–991) vs. 150 (62–317) ng/L; p < 0.001], higher liver enzymes, higher chest x-ray congestion score [2 (1–4.5) vs. 1 (0–2) score points; p < 0.001], and higher mean right atrial pressure (8 ± 4 vs. 6 ± 3 mmHg) and mean pulmonary artery wedge pressure (21 ± 8 vs. 14 ± 6 mmHg; p < 0.001 for both) than those without. After a median post-AVR follow-up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37 ± 11 vs. 32 ± 8 mmHg; p < 0.001), and after a median follow-up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17–3.77); p = 0.01] in LDT compared to non-LDT patients.
Conclusions
LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.
{"title":"Loop Diuretic Therapy in Severe Aortic Stenosis: Marker of Organ Congestion, Unfavorable Hemodynamics, and Increased Post-Valve Replacement Mortality","authors":"Micha T. Maeder, Alexander Breuss, Sharon Appert, Simon Wildermuth, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Martin O. Schmiady, Hans Rickli, Lukas Weber","doi":"10.1002/clc.70225","DOIUrl":"https://doi.org/10.1002/clc.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with severe AS with [<i>n</i> = 157; median (interquartile range) daily torasemide dose: 10 (5–15) mg] or without (<i>n</i> = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Despite similar AS severity (indexed aortic valve area 0.41 ± 0.12 vs. 0.43 ± 0.12 cm<sup>2</sup>/m<sup>2</sup>) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B-type natriuretic peptide [446 (245–991) vs. 150 (62–317) ng/L; <i>p</i> < 0.001], higher liver enzymes, higher chest x-ray congestion score [2 (1–4.5) vs. 1 (0–2) score points; <i>p</i> < 0.001], and higher mean right atrial pressure (8 ± 4 vs<i>.</i> 6 ± 3 mmHg) and mean pulmonary artery wedge pressure (21 ± 8 vs. 14 ± 6 mmHg; <i>p</i> < 0.001 for both) than those without. After a median post-AVR follow-up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37 ± 11 vs<i>.</i> 32 ± 8 mmHg; <i>p</i> < 0.001), and after a median follow-up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17–3.77); <i>p</i> = 0.01] in LDT compared to non-LDT patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The recent systematic review and meta-analysis by Yasmin et al. addressing immediate versus staged revascularization of non-culprit arteries in patients with acute coronary syndrome (ACS) and multivessel disease offers timely and clinically relevant insights [<span>1</span>]. While their work advances the field, several important considerations remain under explored and warrant further attention.</p><p>Procedural complexity is an underappreciated determinant of outcomes. Immediate multivessel intervention often entails longer procedural duration, higher fluoroscopy exposure, and greater operator workload factors rarely captured in randomized trials. These elements are directly linked to complication rates and periprocedural safety. Contemporary evidence demonstrates that operator experience and intravascular imaging improve long-term outcomes in complex PCI, underscoring the importance of workload and expertise as modifiers of risk [<span>2</span>].</p><p>Renal outcomes also deserve greater emphasis. Although the authors note the potential for contrast-induced nephropathy, their analysis does not account for cumulative contrast burden or the possibility of renal recovery between staged procedures. Observational studies have established that contrast volume is a strong predictor of acute kidney injury and adverse prognosis, particularly in patients with impaired baseline renal function [<span>3, 4</span>]. Pooled analyses that omit this dimension may underestimate renal risk associated with either strategy.</p><p>Economic and resource implications are highly relevant but absent from the analysis. Differences in hospital length of stay, catheterization laboratory occupancy, and downstream costs carry meaningful consequences for patients and health systems. Prior studies indicate that staged PCI is associated with higher cumulative costs compared with one-time complete revascularization [<span>5</span>]. These considerations are particularly salient for resource-limited settings where system efficiency influences real-world adoption.</p><p>Physiologic lesion assessment is another key omission. The landmark FAME trial demonstrated that fractional flow reserve (FFR)-guided PCI reduces unnecessary stenting and improves outcomes [<span>6</span>]. Current European guidelines endorse physiology-guided revascularization whenever feasible [<span>7</span>]. Staged procedures allow for reassessment with FFR or instantaneous wave-free ratio following stabilization, which may enhance the appropriateness of intervention and reduce overtreatment.</p><p>Finally, operator and institutional expertise are well-recognized determinants of PCI outcomes. Large registries confirm that both operator volume and the use of intravascular imaging independently improve results [<span>2</span>]. Failure to stratify outcomes by these variables limits generalizability across diverse practice environments.</p><p>In conclusion, while the work by Yasmin et al. contributes signific
{"title":"Nuanced Considerations in Immediate Versus Staged Multivessel PCI: Implications for Clinical Practice and Guideline Development","authors":"Hassan E Muhammad, Samia Nawaz","doi":"10.1002/clc.70224","DOIUrl":"https://doi.org/10.1002/clc.70224","url":null,"abstract":"<p>The recent systematic review and meta-analysis by Yasmin et al. addressing immediate versus staged revascularization of non-culprit arteries in patients with acute coronary syndrome (ACS) and multivessel disease offers timely and clinically relevant insights [<span>1</span>]. While their work advances the field, several important considerations remain under explored and warrant further attention.</p><p>Procedural complexity is an underappreciated determinant of outcomes. Immediate multivessel intervention often entails longer procedural duration, higher fluoroscopy exposure, and greater operator workload factors rarely captured in randomized trials. These elements are directly linked to complication rates and periprocedural safety. Contemporary evidence demonstrates that operator experience and intravascular imaging improve long-term outcomes in complex PCI, underscoring the importance of workload and expertise as modifiers of risk [<span>2</span>].</p><p>Renal outcomes also deserve greater emphasis. Although the authors note the potential for contrast-induced nephropathy, their analysis does not account for cumulative contrast burden or the possibility of renal recovery between staged procedures. Observational studies have established that contrast volume is a strong predictor of acute kidney injury and adverse prognosis, particularly in patients with impaired baseline renal function [<span>3, 4</span>]. Pooled analyses that omit this dimension may underestimate renal risk associated with either strategy.</p><p>Economic and resource implications are highly relevant but absent from the analysis. Differences in hospital length of stay, catheterization laboratory occupancy, and downstream costs carry meaningful consequences for patients and health systems. Prior studies indicate that staged PCI is associated with higher cumulative costs compared with one-time complete revascularization [<span>5</span>]. These considerations are particularly salient for resource-limited settings where system efficiency influences real-world adoption.</p><p>Physiologic lesion assessment is another key omission. The landmark FAME trial demonstrated that fractional flow reserve (FFR)-guided PCI reduces unnecessary stenting and improves outcomes [<span>6</span>]. Current European guidelines endorse physiology-guided revascularization whenever feasible [<span>7</span>]. Staged procedures allow for reassessment with FFR or instantaneous wave-free ratio following stabilization, which may enhance the appropriateness of intervention and reduce overtreatment.</p><p>Finally, operator and institutional expertise are well-recognized determinants of PCI outcomes. Large registries confirm that both operator volume and the use of intravascular imaging independently improve results [<span>2</span>]. Failure to stratify outcomes by these variables limits generalizability across diverse practice environments.</p><p>In conclusion, while the work by Yasmin et al. contributes signific","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertension often coexists with dyslipidemia, requiring combination therapy. Telmisartan, combined with amlodipine or rosuvastatin, targets these conditions. This meta-analysis evaluates the efficacy and safety of these combinations in adults with hypertension and dyslipidemia.
Methods
A systematic search was conducted in Cochrane Central, MEDLINE/PubMed, ClinicalTrials.gov, and ScienceDirect (as of June 2024) for randomized controlled trials (RCTs) comparing telmisartan plus amlodipine versus telmisartan plus rosuvastatin in adults (≥ 18 years) with hypertension and dyslipidemia. A random-effects model was used with RevMan 5.4.1. The risk of bias and heterogeneity were assessed with the Cochrane Risk of Bias Tool and the I² statistic.
Results
Three RCTs involving 320 participants were included. At 4 weeks, telmisartan + amlodipine yielded greater sSBP (sitting Systolic Blood Pressure) reduction compared to telmisartan + rosuvastatin (MD = −10.93 mmHg; 95% CI: −19.02 to −2.83; p = 0.008; I² = 70%). sDBP (sitting Diastolic Blood Pressure) reductions were greater in the amlodipine group at 8 weeks (MD = −8.59 mmHg; 95% CI: −13.35 to −3.82; p = 0.0004; I² = 58%). Conversely, LDL-C reduction was favored by telmisartan + rosuvastatin, with significant effects observed at both 4 weeks (MD = 85.98 mg/dL) and 8 weeks (MD = 79.75 mg/dL). TEAE incidence did not differ significantly (RR = 1.23; 95% CI: 0.75–2.04; p = 0.41; I² = 0%).
Conclusion
Telmisartan + amlodipine demonstrates superior antihypertensive efficacy, while telmisartan + rosuvastatin more effectively lowers LDL-C. Safety profiles are comparable. Findings support the selection of a regimen based on individualized therapeutic goals.
{"title":"Dual-Targeted Therapy in Cardiometabolic Risk: A Meta-Analysis of Telmisartan-Based Combinations for Hypertension and Dyslipidemia","authors":"Rabia Asim, Tazheen Saleh Muhammad, Saad Ahmed, Laiba Khurram, Bazil Azeem, Mata-e-Alla Doggar, Abdullah Naveed Muhammad, Rahul Chikatimalla, Sowjanya Kapaganti, Himaja Dutt Chigurupati, Binish Qureshi, Harigopal Sandhyavenu, Sivaram Neppala","doi":"10.1002/clc.70211","DOIUrl":"https://doi.org/10.1002/clc.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension often coexists with dyslipidemia, requiring combination therapy. Telmisartan, combined with amlodipine or rosuvastatin, targets these conditions. This meta-analysis evaluates the efficacy and safety of these combinations in adults with hypertension and dyslipidemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in Cochrane Central, MEDLINE/PubMed, ClinicalTrials.gov, and ScienceDirect (as of June 2024) for randomized controlled trials (RCTs) comparing telmisartan plus amlodipine versus telmisartan plus rosuvastatin in adults (≥ 18 years) with hypertension and dyslipidemia. A random-effects model was used with RevMan 5.4.1. The risk of bias and heterogeneity were assessed with the Cochrane Risk of Bias Tool and the <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs involving 320 participants were included. At 4 weeks, telmisartan + amlodipine yielded greater sSBP (sitting Systolic Blood Pressure) reduction compared to telmisartan + rosuvastatin (MD = −10.93 mmHg; 95% CI: −19.02 to −2.83; <i>p</i> = 0.008; <i>I</i>² = 70%). sDBP (sitting Diastolic Blood Pressure) reductions were greater in the amlodipine group at 8 weeks (MD = −8.59 mmHg; 95% CI: −13.35 to −3.82; <i>p</i> = 0.0004; <i>I</i>² = 58%). Conversely, LDL-C reduction was favored by telmisartan + rosuvastatin, with significant effects observed at both 4 weeks (MD = 85.98 mg/dL) and 8 weeks (MD = 79.75 mg/dL). TEAE incidence did not differ significantly (RR = 1.23; 95% CI: 0.75–2.04; <i>p</i> = 0.41; <i>I</i>² = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Telmisartan + amlodipine demonstrates superior antihypertensive efficacy, while telmisartan + rosuvastatin more effectively lowers LDL-C. Safety profiles are comparable. Findings support the selection of a regimen based on individualized therapeutic goals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John W. Davis, Steven L. Mai, Wissam Harmouch, Jenna Reisler, Micaela MacKay, Elizabeth Davis, Pavel Osmancik, Michael W. Rich
Introduction
Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear.
Methods
We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion.
Results
There were 476 articles identified from the search and 6 eligible RCTs were included (n = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64–3.46, I2 = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59–1.70, I2 = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18–2.97, I2 = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, I2 = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53–207.98, I2 = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73–94.85, I2 = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45–3.09).
Conclusion
In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.
{"title":"Comparing Effectiveness and Safety of Left Atrial Appendage Closure Devices: A Network Meta-Analysis of Randomized Controlled Trials","authors":"John W. Davis, Steven L. Mai, Wissam Harmouch, Jenna Reisler, Micaela MacKay, Elizabeth Davis, Pavel Osmancik, Michael W. Rich","doi":"10.1002/clc.70217","DOIUrl":"10.1002/clc.70217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 476 articles identified from the search and 6 eligible RCTs were included (<i>n</i> = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64–3.46, <i>I</i><sup>2</sup> = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59–1.70, <i>I</i><sup>2</sup> = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18–2.97, <i>I</i><sup>2</sup> = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, <i>I</i><sup>2</sup> = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53–207.98, <i>I</i><sup>2</sup> = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73–94.85, <i>I</i><sup>2</sup> = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45–3.09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cem Çöteli, Samuray Zekeriyayev, Can Sezer, Hikmet Yorgun, Kudret Aytemir
Background and Objective
Electrical storm is a life-threatening condition commonly observed in patients with structural heart disease. While catheter ablation has emerged as an effective treatment for electrical storm, the long-term outcomes are still unknown. This study aims to evaluate the long-term outcomes of catheter ablation in patients with electrical storm, focusing on mortality, ventricular tachycardia (VT) recurrence, and hospitalization rates.
Methods
We conducted a retrospective cohort study at a single center, enrolling 65 patients admitted with electrical storm. All patients underwent catheter ablation The primary outcome was VT-related ICD therapies, while the secondary outcomes included all caused mortality, VT-related ICD therapies, repeat ablation, hospitalization, and stroke.
Results
The cohort was predominantly male (86.15%) with ischemic cardiomyopathy (56.92%) and a mean left ventricular ejection fraction (LVEF) of 35.3% ± 13%. All procedures were completed without any fatalities and without significant complications in 93.85% of cases. During follow-up, 22 patients (33.85%) received ICD therapies for VT. The median estimated survival time for the VT-free survival was 43 months. The 12-month mortality rate was 26.15%. Over the median follow-up of 23 months, 40% of patients died, and 72% experienced a composite endpoint of death, VT recurrence, or hospitalization. Multivariate analysis identified reduced LVEF as the strongest predictor of mortality during follow-up.
Conclusion
VT ablation is a safe and effective therapeutic option for managing electrical storm, providing high acute procedural success and allowing most patients to be discharged. However, this high-risk population remains at significant risk for long-term morbidity and mortality.
{"title":"Long-Term Outcomes of Catheter Ablation in Ventricular Tachycardia Electrical Storm: A Retrospective Cohort Study","authors":"Cem Çöteli, Samuray Zekeriyayev, Can Sezer, Hikmet Yorgun, Kudret Aytemir","doi":"10.1002/clc.70221","DOIUrl":"10.1002/clc.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Electrical storm is a life-threatening condition commonly observed in patients with structural heart disease. While catheter ablation has emerged as an effective treatment for electrical storm, the long-term outcomes are still unknown. This study aims to evaluate the long-term outcomes of catheter ablation in patients with electrical storm, focusing on mortality, ventricular tachycardia (VT) recurrence, and hospitalization rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study at a single center, enrolling 65 patients admitted with electrical storm. All patients underwent catheter ablation The primary outcome was VT-related ICD therapies, while the secondary outcomes included all caused mortality, VT-related ICD therapies, repeat ablation, hospitalization, and stroke.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort was predominantly male (86.15%) with ischemic cardiomyopathy (56.92%) and a mean left ventricular ejection fraction (LVEF) of 35.3% ± 13%. All procedures were completed without any fatalities and without significant complications in 93.85% of cases. During follow-up, 22 patients (33.85%) received ICD therapies for VT. The median estimated survival time for the VT-free survival was 43 months. The 12-month mortality rate was 26.15%. Over the median follow-up of 23 months, 40% of patients died, and 72% experienced a composite endpoint of death, VT recurrence, or hospitalization. Multivariate analysis identified reduced LVEF as the strongest predictor of mortality during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VT ablation is a safe and effective therapeutic option for managing electrical storm, providing high acute procedural success and allowing most patients to be discharged. However, this high-risk population remains at significant risk for long-term morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12619898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to investigate the electrocardiographic characteristics, electrophysiological features, and outcomes of radiofrequency ablation in patients with focal atrial tachycardia (FAT) originating from the fossa ovalis (FO).
Methods
We retrospectively analyzed 67 patients with FAT originating from the FO and classified into two groups: the Unilateral Ablation Group (n = 36) and the Bilateral Ablation Group (n = 31). Patients in the Unilateral Ablation Group underwent ablation on the earliest single side, whereas patients in the Bilateral Ablation Group underwent ablation on both the right and left earliest sides. Ablation targets were guided by fluoroscopy, three-dimensional mapping, and intracardiac ultrasound. All patients were followed up for more than 1 year.
Results
Out of 1914 patients with atrial tachycardia, 3.5% had FAT originating from the FO. Fifty-four patients were located at the superior area of the FO with positive P waves in inferior leads, while 13 patients were located at the inferior area of the FO with negative P waves in inferior leads. The recurrence rate of FAT was 16.6% in the Unilateral Ablation Group, but no recurrence occurred in the Bilateral Ablation Group during regular follow-up (p = 0.026). Among the six patients with recurrence, five underwent left-sided ablation and one underwent right-sided ablation. All recurrent cases were then ablated by a bilateral strategy. Follow-up showed no further recurrence.
Conclusions
Bi-atrial mapping is necessary for ablation of FAT arising from the FO. Bilateral ablation for FO AT appears to be more reasonable.
{"title":"Radiofrequency Ablation for Focal Atrial Tachycardia Originating From the Fossa Ovalis: Experiences and Outcomes","authors":"Mingxian Chen, Xuping Li, Zhuo Wang, Jiantong Zhu, Min Zhong, Qiming Liu, Shenghua Zhou","doi":"10.1002/clc.70219","DOIUrl":"10.1002/clc.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to investigate the electrocardiographic characteristics, electrophysiological features, and outcomes of radiofrequency ablation in patients with focal atrial tachycardia (FAT) originating from the fossa ovalis (FO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 67 patients with FAT originating from the FO and classified into two groups: the Unilateral Ablation Group (<i>n</i> = 36) and the Bilateral Ablation Group (<i>n</i> = 31). Patients in the Unilateral Ablation Group underwent ablation on the earliest single side, whereas patients in the Bilateral Ablation Group underwent ablation on both the right and left earliest sides. Ablation targets were guided by fluoroscopy, three-dimensional mapping, and intracardiac ultrasound. All patients were followed up for more than 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 1914 patients with atrial tachycardia, 3.5% had FAT originating from the FO. Fifty-four patients were located at the superior area of the FO with positive P waves in inferior leads, while 13 patients were located at the inferior area of the FO with negative P waves in inferior leads. The recurrence rate of FAT was 16.6% in the Unilateral Ablation Group, but no recurrence occurred in the Bilateral Ablation Group during regular follow-up (<i>p</i> = 0.026). Among the six patients with recurrence, five underwent left-sided ablation and one underwent right-sided ablation. All recurrent cases were then ablated by a bilateral strategy. Follow-up showed no further recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bi-atrial mapping is necessary for ablation of FAT arising from the FO. Bilateral ablation for FO AT appears to be more reasonable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12605995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ying Han, Jingzhe Liu, Xiaobo Liu, Hanyue Zheng, Juan Wang, Juan Zhang
Purpose
Despite technological advances, predicting atrial fibrillation (AF) recurrence after catheter ablation remains a clinical challenge. We developed a novel multi-parametric model integrating electrophysiological substrate characteristics, structural remodeling, and inflammatory/metabolic biomarkers to improve risk stratification.
Methods
This retrospective study analyzed 279 consecutive patients undergoing first-time AF ablation (June 2022 to January 2024) with 12-month follow-up. Using a 7:3 training-validation split, we identified independent predictors through multivariate logistic regression.
Results
Four key parameters emerged as powerful predictors: low-voltage zone extent (LVZ), high-sensitivity C-reactive protein (hs-CRP), red cell distribution width (RDW), and left atrial diameter (LAD). The composite model showed exceptional discrimination (AUC, in the training set and 0.84 in the validation set), significantly outperforming both individual parameters (LAD AUC 0.77, LVZ 0.75) and the APPLE score (AUC: 0.73, p < 0.001). The model stratified patients into five distinct risk categories (recurrence risk < 5% to > 70%) with strong clinical utility.
Conclusion
This is the first East Asian study to integrate voltage mapping with hematological-inflammatory biomarkers, providing a cost-effective and precise tool for post-ablation management. The model's performance and generalizability support its adoption in precision medicine pathways, particularly for guiding substrate modification in high-risk patients.
{"title":"A Novel Clinical Score Integrating Low-Voltage Zones and Biomarkers Predicts Atrial Fibrillation Recurrence Post-Ablation","authors":"Ying Han, Jingzhe Liu, Xiaobo Liu, Hanyue Zheng, Juan Wang, Juan Zhang","doi":"10.1002/clc.70218","DOIUrl":"10.1002/clc.70218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Despite technological advances, predicting atrial fibrillation (AF) recurrence after catheter ablation remains a clinical challenge. We developed a novel multi-parametric model integrating electrophysiological substrate characteristics, structural remodeling, and inflammatory/metabolic biomarkers to improve risk stratification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 279 consecutive patients undergoing first-time AF ablation (June 2022 to January 2024) with 12-month follow-up. Using a 7:3 training-validation split, we identified independent predictors through multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four key parameters emerged as powerful predictors: low-voltage zone extent (LVZ), high-sensitivity C-reactive protein (hs-CRP), red cell distribution width (RDW), and left atrial diameter (LAD). The composite model showed exceptional discrimination (AUC, in the training set and 0.84 in the validation set), significantly outperforming both individual parameters (LAD AUC 0.77, LVZ 0.75) and the APPLE score (AUC: 0.73, <i>p</i> < 0.001). The model stratified patients into five distinct risk categories (recurrence risk < 5% to > 70%) with strong clinical utility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first East Asian study to integrate voltage mapping with hematological-inflammatory biomarkers, providing a cost-effective and precise tool for post-ablation management. The model's performance and generalizability support its adoption in precision medicine pathways, particularly for guiding substrate modification in high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145502383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence supporting catheter ablation (CA) for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) is limited. This study evaluated the impact of CA on clinical outcomes in patients with AF and HFpEF using a global clinical database.
Methods
The TriNetX research network identified patients aged ≥ 18 years with AF and HFpEF (February 2014 to June 2024). Patients were categorized by whether they underwent CA for AF. Primary outcomes included all-cause mortality, heart failure (HF) with acute exacerbation, and ischemic stroke. Secondary outcomes included progression to mildly reduced or reduced ejection fraction (EF) during follow-up.
Results
Patients receiving CA showed lower incidences of all-cause mortality, HF exacerbation, and ischemic stroke. There was a trend of less patients with progression to reduced EF in patients with CA. The reduction in mortality was consistent across all subgroups, while stroke reduction was more significant in females, those with better EF, without chronic kidney disease (CKD) or diabetes mellitus (DM), with hypertension (HTN), and with paroxysmal AF. The benefits in reducing HF exacerbation were particularly notable in females, those with better EF, without CKD, and with HTN.
Conclusions
In patients with AF and HFpEF, CA provided cardiovascular and cerebral benefits and might reduce the risk of progression to HFrEF over 5 years of follow-up. Additionally, CA was associated with a reduction in all-cause mortality in patients with AF and HFpEF.
{"title":"Evaluating the Impact of Catheter Ablation on Cardiovascular and Cerebral Outcomes in Atrial Fibrillation With Heart Failure and Preserved Ejection Fraction","authors":"Wei-Chieh Lee, Wan-Hsuan Hsu, Chih-Cheng Lai, Wei-Ting Chang, Chia-Te Liao, Jhih-Yuan Shih, Zhih-Cherng Chen, Hsiu-Yu Fang, Mien-Cheng Chen","doi":"10.1002/clc.70220","DOIUrl":"https://doi.org/10.1002/clc.70220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence supporting catheter ablation (CA) for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) is limited. This study evaluated the impact of CA on clinical outcomes in patients with AF and HFpEF using a global clinical database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The TriNetX research network identified patients aged ≥ 18 years with AF and HFpEF (February 2014 to June 2024). Patients were categorized by whether they underwent CA for AF. Primary outcomes included all-cause mortality, heart failure (HF) with acute exacerbation, and ischemic stroke. Secondary outcomes included progression to mildly reduced or reduced ejection fraction (EF) during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients receiving CA showed lower incidences of all-cause mortality, HF exacerbation, and ischemic stroke. There was a trend of less patients with progression to reduced EF in patients with CA. The reduction in mortality was consistent across all subgroups, while stroke reduction was more significant in females, those with better EF, without chronic kidney disease (CKD) or diabetes mellitus (DM), with hypertension (HTN), and with paroxysmal AF. The benefits in reducing HF exacerbation were particularly notable in females, those with better EF, without CKD, and with HTN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with AF and HFpEF, CA provided cardiovascular and cerebral benefits and might reduce the risk of progression to HFrEF over 5 years of follow-up. Additionally, CA was associated with a reduction in all-cause mortality in patients with AF and HFpEF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 11","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145449847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yiying Zhen, Xiang Yuan, Min Ruan, Huan Lu, Dakai Liang, Dehua Huang, Fengyang Deng, Haozhang Huang, Jiaman Ou
Aims
We employed a robust genetic approach to provide a better understanding of whether Gastroesophageal reflux disease (GERD) contributes to coronary artery disease (CAD) risk from a genetic perspective.
Methods
Multivariable Mendelian Randomization (MVMR) was applied to explore causal links between GERD and CAD using genetic instruments derived from genome-wide association studies (GWAS). The MVMR models were adjusted for key metabolic confounders, including low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), and glycated hemoglobin (HbA1c). Genetic correlations were estimated using linkage disequilibrium score regression. Cross-trait meta-analyses, Heritability Estimation from Summary Statistics (ρ-HESS) and colocalization analyses were performed to identify pleiotropic genes and shared genetic loci, elucidating the genetic relationship between GERD and CAD.
Results
Genetically predicted GERD was found to be causally linked with CAD (rg = 0.38, P = 2.37E-52), independent of metabolic risk factors, including LDL-C, BMI, SBP, and HbA1c (odds ratio: 1.24, 95% CI: 1.02–1.52, p < 0.05). Cross-trait meta-analyses identified eight novel pleiotropic single nucleotide polymorphisms, four of which were independent of metabolic confounders, including rs11764337 in MAD1L1, rs2240326 in RBM5, rs9615905 in FAM19A5, and rs9837341 in BSN. ρ-HESS and colocalization analysis further revealed shared genetic loci for GERD and CAD, specifically rs4643373 in IGF2BP1 (located in chr17: 45876022-47517400 and posterior probability for H4 > 0.75).
Conclusions
GERD is identified as an independent risk factor for CAD. The discovery of shared genetic loci provides novel insights into the genetic mechanisms underlying GERD and CAD, with IGF2BP1 emerging as a potential therapeutic target for intervention.
目的：我们采用了一种强大的遗传学方法，从遗传学角度更好地了解胃食管反流病（GERD）是否会导致冠状动脉疾病（CAD）的风险。方法：采用多变量孟德尔随机化（MVMR）方法，利用来自全基因组关联研究（GWAS）的遗传工具探索GERD和CAD之间的因果关系。对MVMR模型进行了关键代谢混杂因素调整，包括低密度脂蛋白胆固醇（LDL-C）、体重指数（BMI）、收缩压（SBP）和糖化血红蛋白（HbA1c）。利用连锁不平衡评分回归估计遗传相关性。通过交叉性状荟萃分析、遗传力估计（ρ-HESS）和共定位分析，鉴定多效性基因和共享基因位点，阐明GERD与CAD的遗传关系。结果：基因预测的GERD与CAD有因果关系（rg = 0.38, P = 2.37E-52），独立于代谢危险因素，包括LDL-C、BMI、收缩压和HbA1c（优势比：1.24,95% CI: 1.02-1.52, P 0.75）。结论：胃食管反流是冠心病的独立危险因素。共享基因位点的发现为研究GERD和CAD的遗传机制提供了新的见解，IGF2BP1成为干预的潜在治疗靶点。
{"title":"Mapping Gastroesophageal Reflux Disease and Coronary Artery Disease: A Comprehensive Analysis of Multivariable Mendelian Randomization and Shared Genetic Etiology","authors":"Yiying Zhen, Xiang Yuan, Min Ruan, Huan Lu, Dakai Liang, Dehua Huang, Fengyang Deng, Haozhang Huang, Jiaman Ou","doi":"10.1002/clc.70213","DOIUrl":"10.1002/clc.70213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We employed a robust genetic approach to provide a better understanding of whether Gastroesophageal reflux disease (GERD) contributes to coronary artery disease (CAD) risk from a genetic perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multivariable Mendelian Randomization (MVMR) was applied to explore causal links between GERD and CAD using genetic instruments derived from genome-wide association studies (GWAS). The MVMR models were adjusted for key metabolic confounders, including low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), and glycated hemoglobin (HbA1c). Genetic correlations were estimated using linkage disequilibrium score regression. Cross-trait meta-analyses, Heritability Estimation from Summary Statistics (ρ-HESS) and colocalization analyses were performed to identify pleiotropic genes and shared genetic loci, elucidating the genetic relationship between GERD and CAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Genetically predicted GERD was found to be causally linked with CAD (rg = 0.38, <i>P</i> = 2.37E-52), independent of metabolic risk factors, including LDL-C, BMI, SBP, and HbA1c (odds ratio: 1.24, 95% CI: 1.02–1.52, <i>p</i> < 0.05). Cross-trait meta-analyses identified eight novel pleiotropic single nucleotide polymorphisms, four of which were independent of metabolic confounders, including rs11764337 in MAD1L1, rs2240326 in RBM5, rs9615905 in FAM19A5, and rs9837341 in BSN. ρ-HESS and colocalization analysis further revealed shared genetic loci for GERD and CAD, specifically rs4643373 in IGF2BP1 (located in chr17: 45876022-47517400 and posterior probability for H4 > 0.75).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GERD is identified as an independent risk factor for CAD. The discovery of shared genetic loci provides novel insights into the genetic mechanisms underlying GERD and CAD, with IGF2BP1 emerging as a potential therapeutic target for intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sebastian König, Sven Hohenstein, Johannes Leiner, Anne Nitsche, Alexander Staudt, Frank Steinborn, Christian Bietau, Henning T. Baberg, Michael Niehaus, Jürgen Tebbenjohanns, Melchior Seyfarth, Markus W. Ferrari, Marc M. Vorpahl, Ralf Kuhlen, Kerstin Bode, Andreas Bollmann
Background
Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high-risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts.
Methods
We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD-10, OPS, and ATC codes.
Results
We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL).
Conclusion
We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.
{"title":"Management of Antithrombotic Therapy in Patients With Coexisting Atrial Fibrillation and Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention Within the Last Year","authors":"Sebastian König, Sven Hohenstein, Johannes Leiner, Anne Nitsche, Alexander Staudt, Frank Steinborn, Christian Bietau, Henning T. Baberg, Michael Niehaus, Jürgen Tebbenjohanns, Melchior Seyfarth, Markus W. Ferrari, Marc M. Vorpahl, Ralf Kuhlen, Kerstin Bode, Andreas Bollmann","doi":"10.1002/clc.70196","DOIUrl":"10.1002/clc.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high-risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD-10, OPS, and ATC codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 10","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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